Kaiser and Medicare

[Anonymous]

I am trying to help an 80 year old relative navigate some healthcare options.
They live in a continuing care facility and currently have Kaiser insurance. I am unfamiliar with Kaiser, other than knowing the basic model of it being both the insurer and healthcare provider. I am also relatively new to figuring out how Medicare works in conjunction with supplemental insurance.

It seems Kaiser is harder to navigate for those living in places that contract services through independent companies like continuing care and assisted living, but that may just be because I'm not familiar with it.

It's currently open season for this relative and they could switch to Cigna, which I am much more familiar with and would be similar to what I have , but not with the added Medicare layer.

My relative has always stuck with Kaiser because it seemed "easier", but it seems to me the system is not set up to meet the needs of seniors and she is currently have much more trouble than in the past.

Thoughts on using Kaiser in continuing care or assisted living for home health care services (PT, OT, in home care a few hours a week)? Or on changing health insurance at this point in someone's care journey? She has Parkinson's and a recent injury that is limiting mobility, but otherwise is very healthy.

[Anonymous]

The biggest issue is that she Likely will have to change all of her doctors. As you said, Kaiser is unique in being both the insurer and provider. If she switches to Cigna, she won’t be able to see Kaiser docs at all. Even if she takes a Cigna PPO, Kaiser docs won’t be able to see her.

I think you want to ask the assisted living facility if they have providers who come to the facility, and if so, what insurance networks they are part of. That would be convenient.

[Anonymous]

NP here and agree to talk with the assisted living facility.

IF (and I don't know ..) IF Kaiser is the way to go, at least all care decisions are under one roof (so to speak). I would like that. Not having to hunt for doctors.

[Anonymous]

My mom is 80 and has had Kaiser for medicare since age 65. She has had most of the same doctors for most of that time.

It has been pretty seamless. There are no bills to figure out.
There are only copays. I don't have to search for doctors. Kaiser helps me coordinate multiple appointments in a day- general practitioner, specialist, xray., eye doctor etc. Kaiser has been awesome with all things preventative- vaccines, reminders for when the meds are running low, etc.

My mom has had one surgery. We paid the copay and that was it.

[Anonymous]

Consider consulting your local State Health Insurance Program, which is federally funded and provides free counseling for people who are trying to figure out what to do for their Medicare coverage.

https://www.shiphelp.org/

[Anonymous]

Sorry, State Health Insurance ASSISTANCE Program.

[Anonymous]

Anonymous wrote:Consider consulting your local State Health Insurance Program, which is federally funded and provides free counseling for people who are trying to figure out what to do for their Medicare coverage.

https://www.shiphelp.org/

This looks very helpful! Thank you!

[Anonymous]

I recently was in a similar situation with my father who had Kaiser. After a sudden onset of dementia, I ended up moving him into an assisted living facility. The facility had doctors who would come and treat patients, but only those with just medicare (maybe another supplemental insurance). Since he had Kaiser, I had to take him to all of his doctors appointments and pick up all of his prescriptions. Since I had moved my dad over state lines, he had to get a new PCP. I liked that Kaiser was a one stop shop, but I was probably at Kaiser once a week between doctor appointments and prescription pick-ups.

I had planned on dropping Kaiser once open enrollment started. The facility he was in had someone on staff that could help me with the process.

So, maybe check with facility to see if there is someone who can help you navigate the process.

[Anonymous]

Always check with the facility. There will be *some* very competent, helpful people who know all about these situations. they live it everyday.

Keep at it, keep seeking them (the helpful people) if it happens you don't connect to them initially.